This paper will attempt to delineate the
differences between and definitions of, conventional, alternative,
traditional, complementary, natural, holistic, and integrative
medicine. The author begins with the a priori notion that
there are differences between these areas of medicine. Assumptions
about and credibility of "a newly emerging field of medicine" is
greatly impacted by one's understanding of the term used to describe
that field. At least some other medical authors would concur that
word meanings can have a significant impact on credibility,
application and regulation in the profession of medicine.1,2
Clarification of the terms used to describe
different areas of medicine should be based on appropriate word
meanings as found in standard dictionaries. To define is to
"set forth the meaning of; to determine or identify the essential
qualities or meaning of; to fix or mark the limits of; to
characterize (or) distinguish (something)."3 Definitions for
conventional, alternative, traditional, complementary, natural,
holistic, and integrative medicine need to convey the essential
qualities and uniqueness of each field of medicine. Suitable
definitions will benefit insurance companies, healthcare consumers
and practitioners. Whether these definitions become standard appears
to be a matter of politics, power and changing healthcare values of
the American public.
It is important to understand and eventually agree
on the correct terminology that should be used synonymously with
conventional medicine, the dominant medical system in the United
States and other developed nations. Appropriate identifiers for
conventional medicine would include allopathic or orthodox medicine.
The term allopathic (in Greek "allo" means other) medicine was
coined by Samuel Hahnemann, MD, in the late 18th century in
reference to the use of therapeutic modalities which are based on
the assumption that symptoms need to be treated, i.e. opposed.4 The
focus on treating symptoms appears to have developed as one of the
guiding treatment principles in orthodox medicine.
Use of the term conventional or orthodox provides
the dominant medical system in the United States an almost automatic
credibility. Synonyms for orthodox include accepted, approved,
established, sanctioned, and authoritative. Each of these words
connotes a high degree of credibility within the American social,
economic, and insurance structure. In fact, using the terms
conventional or orthodox does not appropriately describe the
practice of that form of medicine (as does allopathic), but rather
provides it with a sanctioned power. The power of those terms are so
great that to some extent they lead to negating the existence of any
other system of medicine.
Although "traditional medicine" is often used
synonymously for orthodox medicine, Webster's definition of
"traditional" would suggest that this term is not an appropriate
identifier for conventional medicine. Traditional is defined as the
handing down of opinions, doctrines, practices, rites, and customs,
especially by oral communication.3 Correct word usage would dictate
traditional medicine be reserved for Chinese, Ayurvedic, Tibetan, or
other indigenous medical systems.5 All of these have century-old
philosophies and practice foundations, which are heavily rooted in
the traditions of each society. Cultural, spiritual and societal
beliefs have largely formed the basis of traditional systems of
medicine. In the sense that allopathic medicine would claim its
basis to be scientific, rather than cultural or spiritual,
traditional medicine should not be used synonymously with orthodox
medicine.
By utilizing the identifier of traditional
medicine, allopathic medicine effectively softens the hard, uncaring
edge of a medicine "at war" with disease. The emphasis on disease
and high technology rather than on health and individualized care,
creates a visit to an orthodox physician which is often replete with
impersonal attendance to a disease entity. Using the term
traditional in fact, helps root allopathic medicine in humanity and
removes it from the cold world of technology and systematized
economic incentives.
The term biomedical is also often used to refer to
conventional medicine.6 This term again conveys credibility and
power to conventional medicine. The assumptions that underlie
"biomedical" medicine are that it is accurate, scientific and
proven. It is a medicine based on the biological understanding of
the organism. Given the tremendous advances in our understanding of
the physical universe, i.e. quantum physics, it is clear that the
biology of living organisms is not as simple as the textbooks would
suggest. In fact, the evidence that the mind and body are one and
that the human body is more than a structural and biochemical entity
is overwhelming.7,8 Recognition that the body has an energetic level
is burgeoning and can be partially explained by quantum physics.
Therapies which are currently within the vast realm of "alternative
medicine," such as acupuncture and homeopathy, may actually be best
explained as therapies which impact physiology via the energetic
level.9 With a more contemporary, comprehensive understanding of
human biology, biomedicine becomes an inappropriate, exclusive
identifier for conventional medicine.
To discuss accurate and appropriate definitions of
alternative, comple-mentary, natural, and integrated medicine
requires clarity regarding the difference between a system of
medicine and the practice of medicine. The dictionary defines the
practice of medicine as the "scientific study of diagnosing,
treating, or preventing disease." Notably this definition does not
include any reference to a system of medicine. The American Medical
Association (AMA) has stated that for any medical system to be truly
credible it needs to have a theoretical basis.10
Despite the apparent absence of allopathic medical
philosophy classes in conventional medical schools, the theoretical
basis of allopathic medicine appears to have stemmed from Pasteur's
findings regarding infectious illness.11 Namely, that a single agent
causes a single type of disease and that a specific therapy can be
used to treat that disease. This has been called the "doctrine of
specific etiology." This simple doctrine along with the quick
symptom-relieving effects of synthetic drugs and surgeries, have
undoubtedly contributed to the dominance allopathic medicine enjoys
today.
Pietroni, a general medical practitioner from the
United Kingdom, has written several short articles posing his
concerns over clarifying terminology in this vast field of
alternative medicine.1,12 He states "Much confusion arises from the
belief that holistic medicine and alternative medicine are the
same."12 He further suggests that there are four distinct aspects to
alternative medical therapies; 1) complete systems, 2) diagnostic
methods, 3) therapeutic modalities, and 4) self-care approaches.
These various aspects of "alternative medicine" should be understood
separately and not under one single definition.
Eisenberg's survey study defined alternative
medicine to mean a treatment which is not taught by US medical
schools or offered at any US hospital.13 Although this definition
was useful for the purpose of Eisenberg's survey, it is somewhat
inaccurate. Alternative medical treatments are taught at
naturopathic medical schools and alternative medicine is often used
to include alternative diagnostic procedures, not just treatment
modalities.12 The term "alternative medicine" is used by many to
mean any medical therapy which is not a synthetic drug or not
surgery. For the purpose of research through the NIH Office of
Alternative Medicine, the definition of complementary and
alternative medicine (CAM) is "CAM is a broad domain of healing
resources that encompasses all health systems, modalities, and
practices and their accompanying theories and beliefs, other than
those intrinsic to the politically dominant health system of a
particular society or culture in a given historical period."2 In
other words, alternative medicine has come to mean a treatment,
which is not the standard of care in conventional medicine.
Basing a whole area of medicine on something which
it is not, rather than on what it is, suggests that there is no
theoretical foundation to the field of alternative medicine. The
author suggests that if the term "alternative medicine" is simply
used to mean therapies, which can be used to treat ill health, but
are not the "standard of care," then the paradigm for practice of
alternative medicine is the same as orthodox medicine. This
translates to a patient with disease X being given herb Y or
nutrient Z to treat their disease. The assumption by the medical
community is that herb Y or nutrient Z is just an alternative to
drug Q.
Natural medicine could be considered a system of
medicine within the field of alternative medicine. It is more than
just an alternative approach to treating a specific disease. A
comprehensive definition of natural medicine would be the science
and art of preventing, curing or alleviating ill health using
treatment modalities in harmony with the laws of nature. Natural
medicine is a medical system, which cares for and treats
individuals, not disease entities. Applying the laws of nature of
the physical/energetic universe to human physiology forms the
foundation principles for the practice, teaching and research of
natural medicine. It is not so much the specific treatment modality,
which defines the field of natural medicine, but rather the approach
to the patient and the paradigm, which is used by the practitioner
to determine a treatment plan. Synonymous with natural medicine is
naturopathic medicine.
Naturopathic medicine began in the United States
in the early 1900's by a German-born healer, Benedict Lust, and was
more formalized and systematized by Henry Lindlahr, MD in his
published volumes on natural therapeutics in 1919.14 Lust defined
naturopathy as the use of nontoxic healing methods derived from the
best traditional healing systems from around the world. The ideas,
theories and practices described in Lindlahr's first two volumes are
so important to understanding the roots and foundations of natural
medicine, that contemporary naturopathic medical schools still use
them as textbooks in naturopathic medical philosophy courses.
As a matter of clarification, a short definition
of homeopathic medicine is presented. Although naturopathic medical
colleges teach the principles and practice of homeopathic medicine,
it is in fact a complete system of medicine. Homeopathy has both a
systematized theoretical and therapeutic basis.15 This system of
medicine was developed by Samuel Hahnemann, MD in the late 1800's.
Hahnemann proposed the theoretical framework and researched specific
homeopathic remedies. The theoretical foundations for homeopathic
medicine are too extensive to be reviewed in this manuscript;
interested readers are referred to several good publications.4,15
The practice of homeopathic medicine is conducted using a natural
medicine paradigm, with the treatment modality always being a
homeopathic remedy. In essence, naturopathic/natural medicine shares
the same medical/healing paradigm as homeopathy, but natural
medicine is more comprehensive and eclectic in its choice of
treatment modalities.
Complementary medicine, like alternative medicine,
is best understood, not as a system of medicine, but rather as a
practice of medicine. Unlike alternative medicine, complementary
medicine is a non-standard treatment given in conjunction with
allopathic therapy, as opposed to instead of a standard
treatment. The allopathic paradigm of disease still guides the
treatment plan. For example, treating hypertension with a synthetic
drug like propranolol (§-blocker), may not effectively lower the
high blood pressure or may produce unwanted side effects.
Complementary medicines could be used in conjunction with
propranolol to help alleviate side effects or help lower blood
pressure to normal ranges.
It would appear that the term complementary is
often used synonymously with alternative medicine.2,6 This does not
seem to be appropriate word usage. A dictionary defines
complementary as "what completes or necessarily coexists with."3
Whereas alternative is defined as "mutually exclusive" or "a choice
between two or more things."3 Clearly, these terms have different
definitions and should not be used interchangeably.
Allopathic doctors may have suggested that these
terms could be interchanged to help keep alternative medicine in its
proper place within the medical system.6 Not surprisingly,
allopathic doctors would view the use of "non-standard" treatments
skeptically and automatically assume they are less effective than
standard treatments. By using complementary as a synonym for
alternative medicine, allopathic doctors are comfortable with
alternative treatments used in conjunction with, but not
instead of allopathic treatments. This inappropriate interchange
of terms creates unwarranted assumptions and dilutes the credibility
of alternative medicines in the mind of healthcare consumers. It
suggests that all non-synthetic agents (i.e. nutrient, herbal, other
supplements) are unproven in efficacy and have all been compared to
synthetic drugs for their overall safety and effectiveness. Until
this type of research has been conducted it would seem that
sagacious use of word meanings dictate "alternative" and
"complementary" be defined as separate and distinct practices of
medicine.
The term holistic medicine used to be a popular
term, and now with the interest in "alternative medicine," is not
used as much. In fact, this author would suggest that holistic
medicine is an archaic and confusing term. Since there is no system
of medicine, known as holistic medicine, and the premise of holism
fits well within the realm of natural medicine paradigm, natural
medicine is probably a more appropriate term.
Finally, integrative medicine has also been used
interchangeably with alternative and complementary medicine.16
Integrative medicine is another term without a foundation
philosophy. Proper word usage would dictate that integrative
medicine be used by a single medical practitioner who is familiar
with allopathic therapeutic armamentarian and alternative medicine
modalities, such that the patient receives "integrated" treatment.
The term "integrative medicine" would also be appropriate for a
clinic in which a patient is treated by both allopathic and
alternative medicine practitioners. Integrative medicine could be
considered synonymous with complementary medicine, as defined here.
In an ideal, non-biased, non-political society,
perhaps integrative medicine should be the term applied to the whole
healthcare system. A system based on physicians fitting into the
scheme of patient care depending on their type of training. For
example, naturopathic physicians are trained in the majority of
"alternative medicine" modalities, while learning how to deal with
patients from a natural medicine paradigm. This training positions
naturopathic physicians as experts in prevention and gentle
treatment of all common ailments and chronic degenerative diseases
which have a dietary and lifestyle, i.e. multifactorial etiology.
While allopathic medical training, with its emphasis on disease
pathology and technology have expert training in high intervention
medicine. When surgery is required, when a potent antibiotic is
required, when a strong, potent drug is required, when life support
systems are required, conventional medicine practitioners have
unparalleled expertise.
In summary, I would propose that accurate use of
the terms "alternative," "complementary" and "natural" medicine
would benefit the health consumer, insurance companies, biomedical
research and the medical community. As the American healthcare
system moves to integrate "alternative medicine" practitioners,
perhaps that integration will be more systematized and appropriate
if the type of medicine that clinicians practice is more clearly
understood. Furthermore, terminology clarification will help guide
the development of appropriate research models and hypotheses. For
example, the effectiveness of natural medicine should be judged
based on the accuracy of its theoretical foundations, whereas the
effectiveness of alternative medicine cannot be judged as a whole,
since it is not a "system of medicine." Only individual,
"non-standard" therapies can be studied as part of alternative
medicine.
Correspondence:
Anna MacIntosh, PhD, ND
P.O. Box 644
Beavercreek, Oregon 97004 USA
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